Inter-Departmental Addiction and Mental Health Action Plan - Priority areas for 2021-2025
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Inter-Departmental Addiction and Mental Health Action Plan Priority areas for 2021–2025 Addiction and Mental Health Branch
Inter-Departmental Addiction and Mental Health Action Plan Priority areas for 2021–2025 Published by: New Brunswick Department of Health Addiction and Mental Health Branch Government of New Brunswick P. O. Box 6000 Fredericton, New Brunswick E3B 5H1 Canada Printed in New Brunswick ISBN 978-1-4605-2734-4 (print edition) ISBN 978-1-4605-2834-1 (PDF: English) ISBN 978-1-4605-2835-8 (PDF: française) 13099
Table of contents Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Current State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Scope and Guiding Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Proven Frameworks and Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Goals and Priority areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Indigenous Focus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Innovation and e-Health Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Moving Forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Appendix A: Work since last action plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Appendix B: New referral statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Background The Action Plan for Mental Health in New Brunswick 2011-2018 led to the development of several foundational documents, created in a collaborative effort to affect transformative change in service delivery. These documents include the Change Vision: Helping People in Their Recovery Journey - Addiction and Mental Health Program Guidelines (2013) and the Provincial Operational Guidelines for Recovery-Oriented Services in the Community (2015). The Action Plan also provided direction and priorities for the work of the Department of Health’s Addictions and Mental Health Branch. This led to numerous projects and initiatives (appendix A), such as implementation of a Live-In Concurrent Disorders Treatment Program in Campbellton; an Intensive Day Treatment Program in Moncton; the Integrated Service Delivery Model for Children and Youth; Flexible Assertive Community Treatment Teams for those with severe and persistent illness; and Supervised Community Care. External critical reports over the same period such as Failure to Protect: Office of the Ombud NB Special Report Regarding the Restigouche Hospital Centre and the 2018 Report of the Auditor General of New Brunswick: Addiction and Mental Health Services in Provincial Adult Correctional Institutions also influenced departmental priorities. Current State Over the past five years, there has been a 16% increase in demand for addiction and mental health services (nine per cent for adults and 33% for youth) (appendix B). Wait times for new high priority addiction and mental health referrals have been on the rise, with less than 50% of high priority cases receiving treatment within national benchmarks. This coupled with an estimated 51% of New Brunswickers identified as being at risk of developing negative mental health impacts as a result of the unprecedented COVID-19 pandemic suggests that the need for support/service will continue to rise. The impact of addictions and mental health issues can also be seen in the realm of Justice and Public Safety. The Crime Severity Index for New Brunswick rose by nine per cent from 2018-2019, driven by increases in mischief, breaking and entering, and trafficking, production, importation and exportation of drugs (i.e. primarily drug-related crimes). New Brunswick currently has the highest Crime Severity Index in the Atlantic Provinces. The Enhancing Addiction and Mental Health Services (2017-2019) project was one of several initiatives undertaken to help ensure continuity following the Action Plan for Mental Health in New Brunswick 2011-2018. For this project, and several others (appendix A), comprehensive consultations were integral components. More than 300 individuals were consulted, including clinicians, clients and their families and a wide range of key stakeholders. The initiatives undertaken and consultations conducted over the last three years have led to over 200 recommendations. A common emerging theme: New Brunswick lacks a continuum of care. Our current services have significant gaps, especially in early stage and lower intensity prevention and intervention. Mental health is also becoming an increasingly prominent area of concern for community partners and the public with a recognition that mental health is as important to one’s overall well-being as physical health. It is an area that has grown in size and scope. Given the broadly defined, cross-cutting nature of the social determinants of health (including income, housing, education, employment and the experience of discrimination or racism) and their significant impact on overall health and well-being, it is recognized that addiction and mental health issues are affected by and impact the work of multiple government departments. This plan was developed to serve as a framework to guide and align current visions, plans and priorities, as well as to foster increased collaboration amongst stakeholders and partners in mental health. The plan is also in line with the three main goals of the Department of Health’s Strategic Plan: (1) Improve the health and well being of New Brunswickers; (2) Increase alignment and accountability of the health system and its partners; and (3) Improve efficiency and effectiveness of delivery of health services. Inter-Departmental Addiction and Mental Health Action Plan Priority areas for 2021–2025 1
Scope and Guiding Principles
It is helpful to view mental health as a continuum, with individuals ranging from being mentally healthy to mentally ill. This
model can help highlight the importance of effectively addressing mental health and addiction concerns early to prevent
more debilitating problems from developing.
HEALTHY REACTING INJURED ILL
Normal Functioning Mild, reversible distress Significant impairment Clinical Disorder
SELF CARE AND SOCIAL SUPPORT PROFESSIONAL CARE
The prevalence of co-occurring addiction and mental health issues is high. This five-year plan takes this fact into
consideration and will ensure an ongoing focus on the integration of addiction and mental health services across the
province. The plan will also support broader integration, collaboration and knowledge exchange between mental health,
acute care, primary care, public health and other government departments that are stakeholders in mental health.
To ensure a comprehensive approach to mental health and addictions from a population-health perspective, a focus on
substance use prevention is an essential complement to the continuum of care. From a population-health perspective,
the use of alcohol, tobacco, vaping products and cannabis continues to be problematic across New Brunswick. This has
significant implications for mental health and well-being, non-communicable disease and premature mortality, intentional
and unintentional injury and community safety. Evidence-informed substance use prevention efforts are required to
improve population health and to decrease the burden on health-care, social and judicial resources. Effective upstream
prevention efforts will reduce the demand for more intensive services thus supporting greater efficiency and capacity within
the addiction and mental health-care system. Most importantly however, this will contribute to a healthier, more resilient
New Brunswick over the long term.
This plan also includes a commitment to closing the gap on inequities. There are regional disparities in services available,
11
there are socioeconomic inequities and there is variable access to technology. Because of this, individuals are not all starting
from the same baseline. Some individuals and some communities will need greater support/action than others to achieve
the same benefits.
Also, for the initiatives contained in this plan to be successful, there is a need to continue to engage stakeholders effectively
throughout the implementation process. This includes both community stakeholders and those with lived experience.
Proven Frameworks and Models
To help provide a clear path forward, proven frameworks were chosen to guide this plan. Based on foundational reports,
practice-based evidence, consultations and resulting recommendations, the adoption of the Stepped Care Model is the first
step in ensuring broad-reaching improvements across the continuum of care and in addressing existing gaps in the system.
The New Brunswick Stepped Care Model is depicted in the following illustration.
Developed at Memorial University in Newfoundland and Labrador, and adapted from the original U.K. model, Stepped Care 2.0
has been identified as the model to help organize services within a flexible larger scale continuum of care in New Brunswick.
Client-centric as opposed to process driven, the model is efficient and effective, and cuts across silos within the overall system.
Matching individuals with the least intensive treatment required with the greatest likelihood of improvement leads to a better
functioning system with increased access. This occurs through a more efficient and self-corrective system of care that provides
ongoing flexibility to step treatment intensity up or down according to a client’s level of distress and need. A key feature of this
model will be the implementation of rapid, same-day access to addiction and mental health services through walk-in services
and web-based information and resources. Early intervention is expected to lead to the prevention of more serious mental
health and addiction conditions. Another unique component of the New Brunswick Stepped Care Model is the addition of
a foundational step for population health promotion and prevention. Population health promotion and prevention extends
beyond the health-care system and differs from individualized approaches to support and service delivery. This work advances
population-wide results by designing policy solutions that ameliorate structural conditions across the determinants of health
and substance use, reducing risk factors and promoting protective factors from a whole-of-society approach.
Inter-Departmental Addiction and Mental Health Action Plan Priority areas for 2021–2025 2Stepped Care Model
Access High Intensity and/or
6
Specialized Services
in-person
telephone
5 Intensive Services
on-line
Health System Stakeholder Investment
4 Community Services &
Recovery Supports
s
es
roc
3 r yP
Brief Services ve
eco
R
2 Self-Directed Care,
Prevention & Navigation
Population Health
1 Promotion and Prevention
Primary Care
Service Intensity, Client Needs and Readiness
Recognizing the multifactorial nature of addictions and drug-related harms, a globally recognized framework for
approaching drug use was chosen to guide efforts to address these issues. The Four-Pillar Approach to drug use was first
implemented in a number of European countries in the 1990s, and has since been incorporated into international, national,
provincial and municipal responses and strategies related to drug and alcohol use. This approach, composed of the
prevention, treatment, harm reduction and community safety pillars, supports a comprehensive and multi-system approach
to addressing this issue. It also recognizes the importance of compassion for those with substance use issues, with the use of
supportive approaches, rather than simply tackling the problem by criminalizing those afflicted with illness. The Four-Pillar
Approach being adopted by New Brunswick is depicted below:
PREVENTION TREATMENT HARM REDUCTION COMMUNITY SAFETY
Abstinence-based and early- A broad range of community- Harm reduction involves an Represents the range of
stage prevention approaches based medical and counselling achievable, pragmatic approach interventions that seek to address
(education, asset development) interventions, outreach support to alcohol and drug issues, and the crime and social disorder
and other biopsychosocial seeks to reduce the individual and related to drug and alcohol use.
programs to support positive societal harms associated with This pillar represents all
behaviour change. substance use. components of the broader
Stopping or delaying the onset
criminal justice system, including
of substance use among youth In addition, feeling connected to Involves safe, monitoring of drug police, the courts, parole/
and addressing the underlying community and belonging to a use, and an acceptance that probation, crime prevention and
causes of drug use, not just the group is critical for both the abstinence is not realistic for all. community-driven initiatives
drug use itself. prevention and treatment of intended to enhance community
addiction. safety and mitigate social
disorder.
7
Inter-Departmental Addiction and Mental Health Action Plan Priority areas for 2021–2025 3Goals and Priority areas
The overall goals of this comprehensive five-year plan are as follows:
• Improve Population Health: reduced risk factors and improved access to what is needed to be healthy;
• Improve Access: faster first contact and reduced wait times for services;
• Intervene Earlier: greater access to prevention and early intervention supports and services;
• Match Individuals to Care: easily navigated and more complete continuum of services and supports; and
• Reduce Drug-Related Impacts: communities that are less burdened by the impact of drugs, such as crime, illness, injury
and death.
Through extensive consultation, research and exploring current best practice, numerous priority areas were identified.
While the five-year plan cannot address all priorities identified, it focuses on 12 key areas that will have a broad impact for
individuals, families, communities and the population as a whole. This plan will also integrate a public health approach
(prevention and health promotion), encourage interdepartmental action and contribute to building an easily navigated
continuum of care for the province.
At present, work is underway to expand live-in concurrent disorder treatment, implement a forensic psychiatry program and
addiction and mental health treatment in correctional facilities, implement the Bridge the gApp online platform and expand
mobile crisis services. Through a phased-in approach, the plan will focus on the following 12 key priority initiatives from
2021–2025:
• Implementation of walk-in addiction and mental health services across the province;
• Addition of addiction and mental health resources to fill current gaps in staffing and prepare for increased demand from
COVID-19;
• Implementation of an education, training and knowledge transfer plan;
• Creation of various forms of supportive housing for addiction and mental health clients, including the implementation of
a clinical consultation model for individuals requiring out-of-home placement;
• Implementation of a guiding document for upstream population health promotion and prevention in New Brunswick,
including a New Brunswick-specific version of the Icelandic Prevention Model;
• Implementation of the provincial treatment centre for youth;
• Implementation of outpatient withdrawal management services in partnership with primary care and a review of
existing detox beds to determine needs and optimal use;
• Development of a service model for individuals presenting with neurodevelopmental disorders;
• Initiation of a psychiatry resource strategy with a focus on recruitment, retention, distribution and access;
• Implementation of regional inpatient youth psychiatric care where needed;
• Expansion of the RCMP Crime Reduction Unit, including resources from the Justice and Public Safety Safer Communities
and Neighbourhoods (SCAN) Unit; and
• Implementation of Overdose Prevention Sites.
Inter-Departmental Addiction and Mental Health Action Plan Priority areas for 2021–2025 4The following illustration details the timeline for the identified priorities over the duration of the five-year plan.
5-year phased-in approach 2020-2025
In progress 2020 2021 2022 2023 2024 2025
Expand Live-In Concurrent Implement Walk-in AD/MH In collaboration with Social Implement the Provincial
Disorder Treatment Services across the province Development, create various Treatment Centre for Youth
forms of Supportive Housing
Implement Forensic Adequate staffing and for AD/MH clients, including Implement Outpatient
Psychiatry Program space: Add additional implementation of a Clinical Withdrawal Management
and AMH Treatment in addiction and mental health Consultation Model for Services (Partnership with
Correctional Facilities staff resources to fill current individuals requiring out-of- primary care) and review
gaps (including ISD and home placement in every need/use of existing Detox Beds
Implement Bridge the gApp adults), and prepare for region
increased demand from Develop a service model for
Expand Mobile Crisis COVID. Initiate Psychiatry Resource individuals presenting with
Service Strategy – recruitment, neurodevelopmental disorders
Implement Education, retention, distribution/access
Training, and Knowledge Implement Regional Inpatient
Plan Youth Psychiatric Care where
needed
RCMP Crime Reduction Unit
Expansion, including
resources from the JPS SCAN
Unit
Implement Guiding Document
Design Provincial Treatment Centre for Youth
for Upstream Population
Health Promotion and
Prevention in New Design Outpatient Withdrawal Management Services
Brunswick, including a New
Brunswick-specific version of
the Icelandic Prevention Develop Regional Inpatient Youth Psychiatric Care Approach
Model
Implement Overdose
Prevention Sites
Measures
It will be important to provide accountability for the provincial resources dedicated to addictions and mental health.
Therefore, the following measures will be used to monitor the benefits gained from this Action Plan:
Reduce rate associated with use of tobacco,
Improve Population Health alcohol, cannabis, and vaping products in
youth and young adults
Remain below national average for hospital
Intervene Earlier stays for harm caused by substance use
Reduce wait time for Community Addiction
Improve Access and Mental Health Services
Maintain or reduce proportion of residents
Match Individuals to Care who reported unmet or only partially met
mental health care needs in New Brunswick
Increase public perception of community
Reduce Drug-Related Impacts safety and security
Inter-Departmental Addiction and Mental Health Action Plan Priority areas for 2021–2025 5Indigenous Focus To support healing from the intergenerational impacts of colonization, First Nations need access to culturally safe addictions and mental health services, treatments and supports. As we move forward we will focus on co-creating and collaborating on the development and delivery of services. In an effort on the part of the Department of Health to move towards better fulfilling the above needs, the Action Plan will take the following specific steps: • Prioritize cultural safety training in the implementation of the Education, Training, and Knowledge Transfer Framework; • Involve indigenous leaders in co-creating new spaces and services so that they are culturally relevant and welcoming; • Promote adoption of Icelandic Prevention Model in First Nations Communities; • Enhance Mobile Crisis Services capacity to respond in First Nations communities; and • Bridge the gApp will contain First Nations-specific Addiction and Mental Health programs and services. Innovation and e-Health Solutions Improvement and modernization of services needs to involve a focus on innovation and e-Health solutions. Self-serve apps for prevention and for individuals with lower levels of need; building networked models for scarce resources like psychiatrists; leveraging tele-health for improved access in under-resourced areas and to subspecialized services like child psychiatry; and implementing innovative models for new approaches to longstanding problems like youth substance use and supporting youth in care will be instrumental going forward. E-Health solutions will provide opportunities to unlock clinical value and address an important gap between traditional services and the use/maximization of technology to further enhance service offerings and increase accessibility to care to a wider net of individuals, including those facing barriers to access. Moving Forward The Government of New Brunswick recognizes the importance of, and urgency in, addressing addiction and mental health in the province. This Action Plan will allow New Brunswick to take steps to address the growing needs of the population. It will work to build an easily navigated continuum of strategies, programs and services, that range from population health- level interventions to specialized intensive inpatient services. It aims to improve the health of the population in general and provide effective services for those experiencing addiction and mental health issues, while also providing early intervention for those with emerging substance use and mental health needs. The plan will also improve access and better match individuals with the least intensive treatment required with the greatest likelihood of improvement, leading to a better functioning system with increased access. References Change Vision: Helping People in Their Recovery Journey - Addiction and Mental Health Program Guidelines (2013), https://www.gnb.ca/0055/pdf/2013/Change_Vision.pdf Failure to Protect: Office of the Ombud NB Special Report Regarding the Restigouche Hospital Centre (2019), https://www.gnb.ca/legis/business/currentsession/59/59-2/LegDoc/Eng/February/FailuretoProtect-Ombud-Feb2019-e.pdf Report of the Auditor General of New Brunswick: Addiction and Mental Health Services in Provincial Adult Correctional Institutions (2018), https://www2.gnb.ca/content/dam/agnb-vgnb/pdf/Reports-Rapports/2018V1/Agrepe.pdf Inter-Departmental Addiction and Mental Health Action Plan Priority areas for 2021–2025 6
Appendix A: Work since last action plan
Work since last Action Plan
Work since last Action Plan
2011 2013 2015 2016 2017 2018 2019 2020
The Action Plan Change Vision: Provincial Detox/Withdrawal Residential Rehab Review Finalize Report of External Advisor: New Brunswick Minister Shephard
for Mental Health Helping People in Operational Management (>150 stakeholders development of Restigouche Hospital Centre and the held Community
in NB (2011- Their Recovery Guidelines for Review consulted, 80 22 Principles of Centre of Excellence for Children and Roundtable
2018) Journey - Recovery- Completed (32 recommendations) Effective Service Youth with Complex Needs
Addiction and Oriented Services recommendations) Delivery Provincial
Mental Health in the Community Review of Outpatient Taskforce Meeting for Integrated Service Education, Training
Program Launch of the Addictions Services (>100 Flexible Assertive Delivery (12 Recommendations) and Knowledge
Guidelines Network of stakeholders consulted) Community Transfer
Excellence Treatment Stepped Care Model Formalized Framework (4
initiative Provincial roll out of the (FACT) service recommendations)
Integrated Service Delivery delivery model Indigenous Youth Mental Health Report
Model implemented in (28 Recommendations) New Brunswick
all zones Crime Prevention
OUTSIDE CRITICAL REPORTS Supervised Community
Care Legislated in New
Improve Access to Community Addiction and Reduction
and Mental Health Services for Adults with Strategy: 2020-
OVER THE SAME TIME PERIOD Brunswick Moderate to High Needs Project (18 2023 Action Plan*
Recommendations)
2011 Overcoming
Staying Connected Report (recommendations Strengthening Addiction and Mental Health Poverty Together 3
re: Child and Youth Centre of Excellence and Services Within the Primary Health Care The New
treatment approaches) Setting Project Brunswick
Economic and
Minister Shephard held Community Social Inclusion
2018
Roundtable Plan*
Auditor General Report – critical of Addiction and
Mental Health Care at Correctional Facilities
2019 OUTCOME HIGHLIGHTS
COMMON
300+ 200+
Failure to Protect: Office of the Ombud NB
Special Report regarding the Restigouche
Hospital Centre
Brief on Equal Access to Mental Health Services THEMES
& Well-being for People with an Intellectual or
NB lacks a full Continuum of STAKEHOLDERS RECOMMENDATIONS
Developmental Disability
Care and has Gaps at Early CONSULTED
Stage Prevention & Intervention
*Existing approved plans that contain action items related to addictions and mental health
Appendix B: New referral statistics
New referral statistics: demand grows
Child & Youth New Adult New Total New
% Increase from % Increase from % Increase from
# of Referrals # of Referrals # of Referrals
Previous Year Previous Year Previous Year
2015/2016 7,424 21,325 28,749
2016/2017 8,499 14% 22,239 4% 30,738 7%
2017/2018 10,165 20% 22,866 3% 33,031 7%
2018/2019 10,396 2% 23,525 3% 33,921 3%
2019/2020* 10,097 -3% 23,313 -1% 33,410 -2%
Total % Increase
33% 9% 16%
over 5 Years
*COVID impact in 2019-2020 numbers
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